The long term objective of the program described in this amended application is to elucidate the role of biobehavioral factors in the etiology, pathogenesis an course of coronary heart disease (CHD) and to use this knowledge to devise more effective prevention, treatment and rehabilitation approaches. The integrating theme is that hostility affects both behaviors and biologic functions in ways that increase the risks of developing coronary atherosclerosis or suffering an acute CHD event. Disciplines involved include psychology, internal medicine, cardiology, psychiatry, pharmacology, biostatistics, epidemiology, and molecular biology. The proposed work builds upon our findings to date that emphasize the influence of anger induced by interpersonal conflicts, interactions with standard risk factors and altered adrenergic receptors in mediating hostility's promotion of CHD risk. Project 1 examines the social, behavioral and biologic concommitants of both natural and experimental interpersonal conflicts as a function of multimodal hostility assessments. Project 2 examines the role of hostility and social support in survival among CHD patients and attempts to identify the behavioral mediators of survival effects. Project 4 will evaluate the effects of hostility, both alone and jointly with risk factors and social factors, on CHD incidence in over 5,000 participants in the UNC Alumni Heart Study. Project 5 will evaluate the effects of age, smoking, lipids, and adrenergic receptors on physiologic reactivity of hostile and nonhostile men to anger induced by interpersonal challenges in the lab as well as the events of daily life. Project 7 will extend the evaluation of anger-associated biologic reactivity in hostile and nonhostile persons by studying biobehavioral responses of 200 women employed in a real world high stress work situation; it will also evaluate the impact of a stress management intervention designed to reduce anger on biobehavioral reactivity in these same employees. Knowledge gained from the work of these projects and their supporting administrative, biostatistical and biochemical cores will increase our understanding of the influence of biobehavioral factors on the etiology, pathogenesis and course of CHD, thereby guiding our efforts to develop more effective and efficient prevention, treatment and rehabilitation approaches to reduce the role of CHD, the nation's number 1 killer.